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The Association of State and Territorial Health Officials (ASTHO), in collaboration with the National Association of State Alcohol and Drug Abuse Directors (NASADAD), developed the Preventing Opioid Misuse in the States and Territories framework to provide a public health-facilitated approach for states and territories to respond to the nation’s opioid crisis. Used effectively, this tool will help states and territories organize resources and look across their jurisdictions to identify where planning is strong, where there are gaps, and where they can expand collaboration and engage in strategic conversations with partners across sectors to coordinate planning.

Partnerships are critical to reducing the devastating impacts of this epidemic. ASTHO strongly encourages multi-sector approaches that pay particular attention to communities in need and rural populations, as these areas experience significant challenges with access to treatment and recovery support. Collaboration with state alcohol and drug agencies that manage each state's publicly funded substance use disorder treatment, prevention and recovery system promotes an effective and efficient statewide system of care. State and territorial public health agencies, state alcohol and drug agencies, health care delivery, law enforcement, and many others have critical roles to play in this strategy and are “co-owners” of a state’s or territory’s response. Collective efforts of public and private partners will bring our nation closer to reducing or eliminating opioid misuse.

The Framework

The framework is built around four key strategies and related objectives for state and territorial health officials to carry out or to ensure are being carried out with other governmental and non-governmental partners as part of a comprehensive response to preventing opioid misuse in their jurisdictions. Each strategy is supported with a list of tactics, and evidence-based tools and promising approaches for addressing the opioid crisis. Additional research is needed to expand the evidence base and assess the most effective approaches necessary to reduce the devastating impacts of this epidemic.

Click on each of the four key strategies below to learn more.

Improve Monitoring and Surveillance of the Use and Health Effects of Prescription and Illicit Opioids

Policy

Improve classification of opioid overdose deaths on death certificates to ensure accurate surveillance of overdoses in the jurisdiction.

Monitor progress in substance misuse prevention efforts using Healthy People 2020, Healthy People 2030 and other national, science-based benchmarks.

Establish data-sharing agreements for tracking of opioid use and overdoses across state agency jurisdictional lines.

Promote and implement evidence-based primary prevention strategies that prevent substance misuse and addiction, including efforts that strengthen family environments for children and youth at risk.

Increase awareness of Adverse Childhood Events (ACEs) and family/parenting supports that can prevent future substance misuse in both parents and children, and utilize the ACEs module of the Behavioral Risk Factor Surveillance System (BRFSS).

Develop or expand community coalitions to ensure a comprehensive and coordinated approach to the opioid crisis in a manner that will allow the coalitions to become part of the community fabric for any public health threat or improvement need.

Limit “doctor shopping” through means such as mandatory PDMP checks that prohibit patients from obtaining controlled substances from multiple healthcare practitioners but ensure they get the specialty care they need.

Promote team-based care in the treatment of opioid use disorder, including allowing nurse practitioners and physician assistants to prescribe MAT.

On Jan. 19, 2018 Acting Secretary Eric Hargan renewed the determination that a public health emergency exists nationwide as a result of the consequences of the opioid crisis effective Jan. 24, 2018. This determination will last 90 days.

On Oct. 26, 2017 Acting HHS Secretary Eric Hargan declared a national public health emergency to address the national opioid crisis. The declaration allows the HHS Secretary to exercise certain emergency measures, as allowed by law, to respond to the epidemic.

As federal agencies and Congress look to implement their response to this public health emergency, ASTHO urges national leaders to provide additional resources focusing on both treatment and prevention of addiction. ASTHO will update the framework accordingly to provide information most relevant to public health leaders in light of the declaration and the recent recommendations from the President’s Commission on Combating Drug Addiction and the Opioid Crisis.